New Hampshire implemented an innovative technical assistance model that promoted organizational change to expand individual employment opportunities. This person-to-person change began at the micro level but "trickled up" through organizations across the state.

In 2000, realizing that the state's growth in integrated employment had stalled, the Bureau of Developmental Services invested aggressively in expanding its intervention strategy by recruiting a community provider to work directly through the bureau. The bureau hired John Vance-the director of ACCESS, a small individualized support organization in New Hampshire-half-time to provide individualized technical assistance to providers across the state. As part of the bureau, Vance established working relationships with providers to expand the rate and quality of employment services, usually through demonstrating job development on a person-by-person basis. Using a hands-on training style, Vance sat down with individuals and their providers to understand personal goals, dreams, and talents, and then directly modeled the support needed to help individuals achieve their employment goals.

Implementation

Prior to hiring Vance, the bureau had dissolved its quality assurance unit, integrating quality improvement responsibilities into program specialists' roles. The central bureau office's six program specialists worked directly with twelve regions. These specialists had built relationships with area agencies in the regions, with a focus on person-to-person quality improvement. In the state office, program specialists were responsible for reviewing ten percent of all adults who received developmental services from the area agencies each year. These reviews focused directly on whether the individual's preferences and needs were being fully addressed. The state expanded this style of intervention by recruiting Vance to work directly for the state in a technical assistance capacity.

Prior to being formally hired by the state, Vance had not only provided supported employment services but worked in many regions to assist individuals and their families with the transition from school to working and living in the community. When working with providers, Vance emphasized real-life demonstrations, one MR/DD representative said:

John just does it and people see. He will go in and work with one individual-and this is often the most challenging person for the agency to find employment for-and he does it, and the providers see it. And so then he will work with another person. I think it's far more powerful than us just lecturing to people or all the trainings that have been provided... It's leadership of a different kind, it's modelin-getting the message out.

In his time with the bureau, Vance was noted for working with organizations over an extended period of time, addressing both values and strategic change. In some cases he worked on-site at a provider several times per week over several months. Typically these agencies were referred to Vance by the bureau. He defined his role as building excitement and commitment through relationships and establishing trust with agency leadership. He worked with management to change the traditional employment services culture and mindset. This change would then trickle down to employment staff working directly with individuals. Vance viewed his role as creating a paradigmatic shift in program leadership:

I worked with [a large agency] for quite a while in terms of just changing how they were looking at things and getting them to understand the difference between just getting a job and becoming integrated, and the difference between controlling people's lives and setting people free through increasing their relationships.

Vance's enthusiasm was obvious. "I see really good people in all the different regions," he said. "If I can do anything to encourage those people... then I feel like I'm pretty successful."

He went on to say: "It becomes my job to show them how it can work
rather then just tell them that it will work. So I need to be able to
show them through concrete examples [of] how it works before they'll believe me."

Indeed, one of the conditions of his state contract was that Vance continue his work as an employment supports provider, so that he would stay engaged with the actual work and creativity of helping people develop meaningful jobs that result in community connections.

Although Vance was no longer under contract with the bureau at the time of ICI's research, the regions could still access his assistance. New Hampshire's Specialty Services waiver allowed area agencies to use state funds to continue to finance Vance's in-depth technical assistance.

Impact

Vance was most effective when working with providers who were "ready to listen and reconsider their approach." In addition, successful outcomes were more apparent when his approach aligned with those of family members who insisted on individualized and innovative services that went beyond the typical model. A bureau administrator noted that Vance's approach would be best supported by a full-time staff person who worked consistently with agencies with the full support of bureau management. The New Hampshire system's vision evolved from helping people find jobs to creating community connections that supported all its members.

Suggestions for Replication

Identify model providers in the state that consistently attain good employment outcomes.

Contract with effective providers to provide technical assistance to agencies that struggle with supporting individuals in community employment.

Set up a data tracking system to chart the progress of sites that receive technical assistance.

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